Cervical heart syndrome
The cardiac symptoms and ECG changes caused by cervical spondylosis are called cervical heart syndrome. Since cervical spondylosis and coronary artery disease are both common in middle-aged and elderly people, they are easily misdiagnosed as coronary angina. The reason for this is that cervical spondylosis can cause the medial branch of the C7 to Tl
The medial branch of the anterior thoracic nerve and the lateral branch of the anterior thoracic nerve are compressed, causing pseudo-angina; or when the anterior oblique muscle spasm is caused, compressing the brachial plexus nerve, or when the posterior branch of the spinal nerve is compressed by the spasm of the oblique muscle, it can cause spasticity of the left intercostal muscle
pain, producing pseudo-angina. Compression of nerve roots by cervical spondylosis can directly cause spasm of the left thoracic major muscle, resulting in pseudo-angina. Compression of cervical spine joint osteophytes stimulates the cervical sympathetic nerves and stimulates impulses to spread downward through the subcardiac
and cardiac sympathetic branches, producing visceral sensory reflexes and causing angina pectoris.
Clinical features
1. Needle-like pain or distension in the precordial region, lasting more than 15 minutes, sometimes up to several hours.
2. Nitrate preparations cannot stop cervicogenic pseudo-angina, and the electrocardiogram does not change significantly in cardiac stress test, and antiarrhythmic drugs also have difficulty in controlling cervicogenic arrhythmia.
3.Cervical spine radiographs all have obvious pathological changes.
4. After treatment of cervical spondylosis, the abnormal cardiac manifestations can be improved with the improvement of cervical spondylosis.
If a patient with arrhythmia of unclear etiology is encountered clinically, accompanied by dizziness, sweating, neck and shoulder pain, soreness and numbness, or easily triggered by head and neck rotation, and the effect of regular antiarrhythmia is not good, the possibility of cervical spondylosis should be thought of, and X-ray or CT examination should be given in time to clarify the diagnosis.
Cervical hypertension
Cervical spondylosis can cause an increase or decrease in blood pressure, with an increase in blood pressure being more common, called cervical hypertension. Its occurrence may be related to the dysfunction of the vertebrobasilar artery supply and sympathetic nerve stimulation caused by cervical spondylosis.
Clinical features
1. Typical symptoms and signs of cervical spondylosis are present, and blood pressure increases beyond normal standards.
2, often accompanied by vertebrobasilar artery supply deficiency or cervical heart syndrome.
3. The duration of cervical spondylosis is usually more than 1 year.
4. Antihypertensive drugs are usually ineffective, and after treatment of cervical spondylosis, blood pressure often decreases to normal.
Cervical syncope
Sudden syncope can occur in cervical spondylosis, called cervical syncope, which is easily misdiagnosed as cerebral arteriosclerosis or cerebellar disorders. The syncope is caused by insufficient blood supply to the basilar artery due to compression of the vertebral artery by proliferative changes in the cervical spine.
Clinical features
1. There is often a history of typical cervical spine disease.
2. The body loses support and suddenly falls to the ground when the head is suddenly twisted during walking, and can wake up quickly after the fall due to the change of the neck position without sequelae.
3. It is often accompanied by recurring episodes of vertigo, the occurrence of which is related to the change of neck position.
4. There may be headache, nausea, vomiting, sweating and other symptoms of plant nerve dysfunction. Signs of hypertrophic cervical spondylosis can be seen by taking cervical spine photographs, and vertebral arteriogram and TCD examination can show vertebrobasilar artery stenosis.
Cervical dysphagia
Swallowing difficulty caused by cervical spondylosis is also called cervical dysphagia. Its mechanism.
1, the posterior wall of the esophagus is directly compressed by the bone flab at the anterior edge of the cervical spine and causes stenosis spasm.
2.Cervical spondylosis causes plant nerve dysfunction resulting in esophageal spasm or excessive relaxation.
3.The formation of bone spur is too long causing soft tissue irritation reaction around the esophagus.
4.The bone spur is located at the level of the opening of the esophagus, and it is easy to obstruct the movement of the esophagus, even if the bone spur is also easy to produce symptoms.
Clinical characteristics
1.The main manifestation is dysphagia and foreign body sensation in the esophagus.
2.The difficulty in swallowing is sometimes mild and sometimes severe, non-progressive, often accompanied by other manifestations such as neck and shoulder pain and numbness of the upper limbs of varying degrees.
3.A few patients have symptoms such as swallowing pain, nausea, vomiting, hoarseness, dry cough and chest tightness.
4.The lateral cervical spine film can be seen as obvious changes such as bone flab protruding forward, barium meal examination of esophagus can observe the stenosis site, and CT can clearly show the hyperplasia of the anterior edge of cervical spine and the degree of esophageal compression.
5.Hormone and anti-inflammatory drugs (such as anti-inflammatory pain) can be relieved after treatment, but it is easy to recur.
Cervicogenic headache
Cervicogenic headache is a group of syndromes caused by organic or functional lesions of the cervical-occipital region or (and) shoulder tissue, mainly ipsilateral headache. Pathogenesis.
1. The posterior branches of C1, C2 and C3 nerves and their branches from the cervico-occipital region are distributed in the corresponding ipsilateral head.
2. The C1, C2 and C3 nerves and their branches in the neck are connected to or converge with certain ganglia or nuclei that innervate the head and face. The headache starts from the abnormalities of single or multiple tissues in the cervical-occipital region or (and) the shoulder, resulting in localized organic or functional changes of the nerves.
Clinical features
1. Patients with cervicogenic headache are often accompanied by cervical-occipital or (and) shoulder symptoms, and the headache can be relieved or disappeared after treatment of cervical spondylosis. Most of them simply deal with the headache during the diagnosis and treatment, but ignore the cervical-occipital or (and) shoulder symptoms, resulting in a lingering headache.
2.Cervical visual impairment
3.Cervical spondylosis can cause loss of vision, eye distension, photophobia, tearing, unequal pupil size, and even reduced visual field and sharp loss of vision, and a few patients can also cause blindness, which is called cervical visual impairment. The cause may be related to ischemic lesions of the visual center of the occipital lobe of the brain secondary to the vegetative nerve dysfunction caused by cervical spondylosis and insufficient blood supply to the vertebrobasilar artery.
Clinical features
1. Ocular symptoms and cervical spondylosis occur simultaneously or sequentially, and the two conditions are closely related to each other.
2. Intermittent blurred vision and painful swelling in one or both eyes in the early stage, followed by other ocular symptoms.
3.The cause cannot be found by ophthalmological examination, and treatment according to ophthalmology is ineffective. After treatment according to cervical spondylosis, the vision can be significantly improved with the remission of cervical spondylosis.
Spinal cord type cervical spondylosis (CSM)
Spinal cord-type cervical spondylosis has an insidious onset and extremely atypical clinical symptoms, which can easily lead to clinical misdiagnosis and mistreatment. In the past, this disease was considered rare, but in recent years, due to the continuous improvement of diagnosis, it is not uncommon to find this disease, and the incidence accounts for 5% of the total incidence of cervical spondylosis.
CSM has an insidious onset and complex clinical manifestations, which may include tremor of one limb, twitching, burning sensation in one finger or palm, fear of cold, morning stiffness, weakness of lower limbs, hard of hearing in one ear, pain in both ears, incomplete sensation of urination and defecation, etc.
The patient’s history was not careful enough. Insufficient careful examination and history taking, lack of comprehensive analysis of the collected clinical data. Some pathogenic factors often do not show up on the cervical spine X-ray, so the diagnosis cannot be implicitly ruled out only on the basis of X-ray plain film.
The diagnosis should be excluded implicitly, and further myelography, CT or MRI examination should be done.